Healthcare Provider Details

I. General information

NPI: 1346419421
Provider Name (Legal Business Name): MARION COUNTY ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 SOUTH MAIN ST
MARION SC
29571
US

IV. Provider business mailing address

508 SOUTH MAIN ST
MARION SC
29571
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-6220
  • Fax:
Mailing address:
  • Phone: 843-423-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC-112
License Number StateSC

VIII. Authorized Official

Name: MR. PHILLIP EDWARD HUDSON SR.
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 803-432-9900